From relaxed-but-conscious to deep sleep – possibilities of modern anesthesia in dentistry

Thanks to effective local anesthetics, dentist patients no longer have to suffer pain in the dental chair. In addition, three forms of general anesthesia are available to dentists for longer, complex procedures or for "complicated" patients for one reason or another.

Sedation, twilight sleep and anesthesia

The transition between these three forms is fluid and primarily a question of dosage. In principle, all three stages can be brought about with many active substances in a dose-dependent manner – even if other medications are used for sedation and twilight sleep than for general anesthesia. Accordingly, the available anesthetic measures offer a spectrum of finely tuned options. This

allow anxious patients to get through the necessary diagnostic and therapeutic measures without sweating and panic
make tedious and complicated interventions more bearable
help anxious children or handicapped people whose insight is not (yet) sufficient to engage in dental treatment.

Here you can read a brief comparison of the three forms of anesthesia; each will have its own contribution.

Sedation: relaxed and fearless, but awake

With sedation, you are awake and conscious, you are available at all times and can follow the dentist quite well if he explains something to you or gives you instructions. You breathe alone, and other important protective reflexes (swallowing, coughing) also work, albeit perhaps somewhat slower. Gaps in memory can, but do not have to occur.

Sedation is generally oral (by taking one tablet). Injection of a small dose of a sedative is also possible. Oral sedation can help anxious patients and children to survive preventive examinations, diagnostic measures and small, short interventions more relaxed.

Sedatives do not relieve pain. Therefore, when a potentially painful treatment is pending, they are supplemented with a local anesthetic. Alternatively, sedation can also be carried out with nitrous oxide.

Dusk Sleep Treatment: Far away, but still responsive

In the twilight sleep state, your consciousness is not really “there” most of the time. They sleep, but breathe independently and can be awakened at any time. Then you can also answer questions or follow instructions. Later, you may have no or very vague reminder of the treatment.

The twilight sleep sedation takes place via an intravenous access. The same active ingredients are typically used as for simple sedation, if necessary in combination with an analgesic (pain reliever) – locally and / or also intravenously. After an initial, higher-dose dose, the sedative is added at intervals to maintain the desired degree of sedation. The treatment in twilight sleep is therefore also suitable for longer procedures.

Anesthesia: Deep, unconscious sleep

During anesthesia (see anesthetic dentist) your consciousness is completely switched off. And not only that: your breathing muscles and the muscles responsible for coughing and swallowing also “sleep”. This means that you have to be intubated and artificially ventilated during the anesthesia – this happens nasally at the dentist, because there is obviously not really room for the breathing tube in your mouth. Short anesthesia is an exception (max. 15 minutes for very short procedures): it does not require ventilation; You only get additional oxygen through so-called nasal cannula.

The drugs for anesthesia are also introduced via an intravenous line and are added during the procedure; however, there is also the rather rarely used alternative of inhalation anesthesia with anesthetic gases. From the moment you start anesthesia, do not keep any reminder of the procedure.

You don’t even do anesthesia on the side. It may only be carried out by an anesthetist (there are mobile anesthetists who make the rounds in several dental practices) and requires a careful anamnesis and preparation as well as of course the most careful implementation including monitoring of the vital functions. You remain under observation even during the wake-up phase. Implantations, complicated wisdom tooth removal and other jaw surgery are typical reasons for anesthesia. Anesthetic is an option for anxious patients and children, even with extensive caries treatments (multiple teeth, root canal (s)) – but should not be taken lightly.

Risks of sedation, twilight sleep and anesthesia

The risks of sedation and twilight sleep treatment are minimal. The most important, small, but absolutely to be considered risk is that of respiratory depression. This is a potentially dangerous flattening of your breathing that is caused by your muscles just a little bit too much relaxed. Therefore, you must remain under observation during the period of anesthesia. In the case of twilight sedation, the oxygen content of your blood is also monitored with the pulse oximeter finger clip. If the worst comes to the worst, the dentist’s office provides pure oxygen, breathing masks and quick-acting antidotes.

Since you are ventilated during anesthesia, the risk of breathing disorders essentially shifts to the wake-up phase – so you have to remain under observation for an hour or two. Another important risk of anesthesia is that of cardiovascular complications (drop in blood pressure, irregular heartbeat, heart attack). Modern anesthesia has developed effective protocols to respond to such situations. This and the permanent monitoring of the vital functions also make general anesthesia a low-risk procedure. The mortality risk for patients without significant previous illnesses is currently estimated at 0.00004 percent (0.4 / 100,000).

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